From The Appeals Desk Episodes
From the Appeals Desk: Coding Clinics and Sepsis
Many payers state that a 2016 Coding Clinics article allows them to deny sepsis DRGs. This is not true, and Dr. Hassaballa goes into the article and what is specifically says about sepsis. And, he issues an unequivocal condem...
Great Minds in Medicine: Dr. Vivek Tirmal
Insurance companies will use obscure “Coding Clinics” articles to deny various DRGs. I asked appeal expert Dr. Vivek Tirmal of Sound Advisory Services all about this.
Know Your Sepsis
As we conclude Sepsis Awareness Month, Dr. Hassaballa discusses how the definition of sepsis changes depending on which insurance company the patient uses.
From the Appeals Desk: Acute Respiratory Failure
In this latest episode in the series, "From the Appeals Desk," Dr. Hassaballa discusses acute respiratory failure and how to protect yourself and mitigate against denials of this diagnosis by insurance companies. This is a pu...
The ”30 Day Readmission” Denial
In this episode, Dr. Hassaballa discusses the most frustrating denial he deals with: the "30 Day Readmission" denial. It is purported to be similar to that by CMS, but this is totally false. Reference: https://www.cms.gov/med...
What is the Two-Midnight Rule?
Starting in 2024, Medicare Advantage plans must follow the Two-Midnight Rule. So, it behooves all clinicians to know that this rule is and document appropriately against it. Reference: https://www.beckerspayer.com/policy-upda...
From the Appeals Desk: Medical Necessity Denials
In this episode, Dr. Hassaballa discusses medical necessity denials: what they are and how to deal with them. Resources: Interqual: https://www.changehealthcare.com/clinical-decision-support/interqual MCG: https://www.mcg.com...
From the Appeals Desk: Prior Authorization Denials
Insurance company denials are terribly frustrating. There are a number of causes, and in this series, we will explore the types of denials and what we can do to mitigate them. Resources: "From the Appeals Desk": https://healt...